<!DOCTYPE html>
<html>
<head>
<meta charset="UTF-8">
<title>Tough by TCGeek</title>
<style type="text/css">

body { background-color: #ffffff; }
.CI {
text-align:center;
margin-top:0px;
margin-bottom:0px;
padding:0px;
}
.center   {text-align: center;}
.cover    {text-align: center;}
.full     {width: 100%; }
.quarter  {width: 25%; }
.smcap    {font-variant: small-caps;}
.u        {text-decoration: underline;}
.bold     {font-weight: bold;}
</style>
</head>
<body>
<h1><a href="https://archiveofourown.org/works/28586436">Tough</a> by <a class='authorlink' href='https://archiveofourown.org/users/TCGeek/pseuds/TCGeek'>TCGeek</a></h1>

<table class="full">

<tr><td><b>Category:</b></td><td>Caduceus | Trauma Center Series</td></tr>

<tr><td><b>Genre:</b></td><td>Anesthesia, COVID, Gen, Medicine</td></tr>

<tr><td><b>Language:</b></td><td>English</td></tr>

<tr><td><b>Status:</b></td><td>Completed</td></tr>

<tr><td><b>Published:</b></td><td>2021-01-06</td></tr>

<tr><td><b>Updated:</b></td><td>2021-01-06</td></tr>

<tr><td><b>Packaged:</b></td><td>2021-05-13 06:01:40</td></tr>

<tr><td><b>Rating:</b></td><td>Teen And Up Audiences</td></tr>

<tr><td><b>Warnings:</b></td><td>Creator Chose Not To Use Archive Warnings</td></tr>

<tr><td><b>Chapters:</b></td><td>1</td></tr>

<tr><td><b>Words:</b></td><td>2,511</td></tr>

<tr><td><b>Publisher:</b></td><td>archiveofourown.org</td></tr>

<tr><td><b>Story URL:</b></td><td>https://archiveofourown.org/works/28586436</td></tr>

<tr><td><b>Author URL:</b></td><td>https://archiveofourown.org/users/TCGeek/pseuds/TCGeek</td></tr>

<tr><td><b>Summary:</b></td><td><div class="userstuff">
              <p>A look into the coronavirus pandemic, from the view of the Iron Vixen.</p>
            </div></td></tr>

<tr><td><b>Comments:</b></td><td>6</td></tr>

<tr><td><b>Kudos:</b></td><td>7</td></tr>

</table>

<a name="section0001"><h2>Tough</h2></a>
<div class="story"><div class="fff_chapter_notes fff_head_notes"><b>Author's Note:</b><blockquote class="userstuff">
      <p>In case anyone is curious what a typical day in a pandemic looks like, this is my job.</p>
    </blockquote></div><div class="userstuff module">
    
    <p><strong>11:13 pm</strong><br/><br/>I twirl a long strand of pasta around my fork.</p><p>It’s long been connected, but I keep twirling. Slowly, round and round, my eyes down on it with my head propped up by my other hand. I wish I was hungry.<br/><br/>Hospital food isn’t my favorite. I used to pack a lunch every single day, but that would require enough time spent at home to have groceries in the refrigerator and one fucking moment to do anything but go to my bed and collapse in exhaustion. In case it wasn’t clear, I don’t have that time. I haven’t for awhile.<br/><br/>I’m in month nine of a worldwide pandemic, and it blows insane amounts of ass.<br/><br/>Just as I’m force-feeding myself another mouth of spaghetti, I jolt in my seat when my phone blares a happy chime I chose for it when I thought it was upbeat and fun. It’s been tainted since then – the tune now carrying a morbid undertone that reminds me of why they use children’s songs in movies where killer clowns come to murder us all. It’s chilling. It drops my heart straight into my stomach, where it festers with food that could come up at any minute.</p><p>I wish for something different than what I know is coming, but I see the caller ID and my hopes are short-lived.<br/><br/>“Anesthesia, this is Cybil.”<br/><br/><em>“Hi, this is Dr. Wellington in the ER. Can you come intubate room 15 for us? He’s stable now but quickly headed in the wrong direction.”</em></p><p>“COVID?” I respond, knowing the answer before he gives it. Room 15 is one of the emergency room’s negative pressure rooms – the airflow is different, and it is utilized for respiratory diseases such as tuberculosis rule-out’s and lately, coronavirus patients.<br/><br/><em>“Yes, ma’am. See you shortly.”</em></p><p>“I’ll be there as soon as I can.”</p><p>Thankful for a reason to stop pretending to like this shitty dinner, I push from my desk and stand with a heavy sigh. I don’t mind taking care of these patients, unlike some of my colleagues. I’ve studied long and hard to understand the intricacies of how to properly manage these intubations, constantly pouring over new data and research as it emerges. I helped write policy for our department, amending it over the course of this year as recommendations have changed. I’ve helped roll our anesthesia machines to makeshift ICUs when we ran out of ventilators and stayed on call to run them, as they have built in vents that can be used for non-COVID ICU patients that require less support, but cannot be managed by non-anesthesia personnel. I’ve run to codes, and I’ve performed anesthesia for surgery on patients currently infected – I know my shit.<br/><br/>Even this, an emergency room intubation, is another way life and practice have changed for me. The ER is full of its own attendings that usually manage this on their own, but since the pandemic began, the recommendation has been for the most experienced airway provider to be in control of these delicate situations, which, by and large, is anesthesia. We are the airway experts. <br/><br/>Normally I’d have some more people in tow, but our students are nowhere near these situations, in most cases prohibited by their institutions from caring for COVID patients to protect them and also to avoid over-use of personal protective equipment that is already in short supply. Life is different. It’s lonelier, even when I’m one of the few these days that gets to have regular human interaction at my essential work.<br/><br/>I call the nurse anesthetist who is on call with me and within minutes, she and I are standing in the lounge together getting dressed. She’s going to perform the intubation this time and I will act as her backup, dressed and ready to enter at a moment’s notice but waiting outside to prevent unnecessary exposure. Intubation is an aerosol generating procedure – the highest transmission risk due to direct instrumentation of the airway and aerosolization of respiratory particles as we place the tube. It is for that reason we dress thoroughly, the process the same every time to prevent exposure to ourselves, each other, and our families.<br/><br/>Stephanie’s watch, phone, and badge are placed in a pile on the desk as she pulls the straps of an N95 into place on top of her head. She replaces her cloth hat with a disposable blue bouffant, places the CAPR helmet on her head, and tightens the back of it until it rests securely. The cord dangling from it is plugged into a battery pack attached to her hip, the fan from the helmet beginning to whir and blow filtered air the second she clicks it into place. Three green lights shine at the top and are visible for the time she wears it, each one disappearing as the battery draws closer to empty and threatens to cut her air supply and protection. Early on, a CRNA (and the rest of us by default) learned the lesson of the need for a backup mask the hard way, when a malfunctioning battery pack cut out in the middle of surgery. He frantically called for help and a backup mask and goggles, forced to rip the CAPR off mid-case as without the air flow, he felt like he was suffocating.<br/><br/>Thankfully he tested negative, but we never traveled without back-up again.<br/><br/>I affix the plastic shield to the front of the helmet and Stephanie reaches on the inside of it, her fingers pulling the plastic membrane down until it fits snugly around her chin. Now it is a positive pressure respirator, and she is much less at risk for exposure. However, we are just beginning, dressing in tandem while silence hangs between us. She’s as exhausted as I am – their staff is down quite a few people after positive tests, and she has been pulling insane amounts of overtime to help while also worrying about the health and safety of her toddler at home.</p><p>We hand each other supplies and help adjust our gear as we continue. Knee high boot-covers, one pair of long surgical gloves under a pair of regular gloves, a surgical gown, a hood with a clear plastic front shield for her, a hat/beard cover that protects my face and neck for me. We grab our supplies and are out the door.<br/><br/>--<br/><br/><strong>1:23 am<br/><br/></strong>It’s my phone again, but it’s not the happy chime. <br/><br/>It’s a high-pitched, shrieking alarm, one that rockets me out of bed and forces my blurry eyes to attempt to adjust to a bright screen with a flashing red warning.</p><p>-CODE BLUE: ICU 213-<br/><br/>“Fuck.” I mutter under my breath, sprinting for the cart full of supplies I now keep stocked in my call room. It’s one of the COVID units – someone is coding and dying, but the process remains the same. I have to get to them as fast as possible to give this patient a shot at surviving, but I can’t be lax with my own protection.</p><p>“There is no emergency in a pandemic.” I say softly to myself while piling on layers as fast as I can, a mantra that helps me to remember that even in an emergency, things must be done the correct way. This is nothing new for me, especially during my days on the force – my M.O. is running into situations that everyone else is running away from. However, when I want to charge into these rooms and help these patients as quickly as I normally would, I take pause. I remember that if I or my colleagues are irresponsible in protection and all go down, that nobody stands ready to care for this massive pile-up of sick human beings. It is against every human nature we have as health professionals to follow this, but it’s a necessary fact that I make sure to repeat to myself every time I feel the push to take a shortcut.<br/><br/>In a matter of seconds I’m running down the hall toward the ICU. I can hear another set of boot covers swishing behind me, a brief sense of calm passing over me at the reminder that my backup will once again make sure I’m not alone in what I’m about to do.<br/><br/>I round the corner and throw my tackle box on the ground, eyes flashing through the glass window as the team performs chest compressions. I assemble the parts of my video laryngoscope while Stephanie puts a rigid stylet in my endotracheal tube and attaches a syringe to fill the balloon. I elbow the door handle and leave my counterpart on the other side of the glass, a watchful eye waiting for my signal should I get in over my head.<br/><br/>“Anyone who is non-essential to this situation should step out right now!” I shout, talking much louder than I’m used to due to the fan blowing next to my head. I see someone leave and I bend, twist, and crawl around lines and wires until I’m where I need to be. I remove the headboard and look down at the patient, and I swear my heart stops beating for a second.</p><p>My eyes shoot upward and meet the nurse at the end of the bed, her expression knowing, as it matches mine.<br/><br/>“30.” she states, knowing by the look on my face that I understand why her eyes are filling with tears.<br/><br/>I hesitate, looking down as the patient’s head bobs around, team members switching out who is responsible for compression as they fatigue, which is much quicker in the massive amount of PPE required to be in the room. I shake it off and turn on my laryngoscope, use my fingers to push against the patient’s molars to open his jaw, and insert my blade. Compressions continue as I pull up on my blade, my eyes searching the surrounding anatomy for vocal cords, and I breathe a sigh of relief as I locate them just under a large, floppy epiglottis. I place my tube in the mouth and guide the tip and the blue balloon toward the cords, the respiratory therapist at my side pulling the stylet from the tube at my instruction. The balloon is inflated and the patient is placed directly onto the ventilator, a precaution taken to prevent the number of times the breathing circuit is opened and particles leeched into the environment. I look to the machine and see the carbon dioxide tracing, meaning my job here is done. The tube is secured by the staff while I remove my top pair of gloves and throw them and my disposable blade into a trash bag that I immediately tie off to prevent contamination.<br/><br/>I trudge to the door and hand my video laryngoscope to Stephanie, who stands ready with bleach wipes to disinfect it. As she does this, I remove my gown and turn it inside out, balling it up away from my body. Next are my shoe covers, and then I take a wipe she passes me through a crack in the door and use it to thoroughly wipe down my helmet and face shield. I remove my gloves, step out into the hallway, and wipe my helmet again with another fresh bleach wipe and pair of gloves. I remove my face shield, turn off my battery pack, and my gloves are thrown into the trash. <br/><br/>“Are you alright?” Stephanie queries. I suppose the look on my face hasn’t changed much.<br/><br/>“30 years old.” I say quietly, and she rightly gasps. And instead of rushing back to our respective call rooms, we stand on the other side of the glass, watching the team make a desperate attempt to save someone we know is already gone. Our fears are confirmed 15 minutes later when compressions cease, the staff visibly shaken. The same nurse who met my eyes slips her hand into the patient’s and stands at his side as everyone else trudges away, and it is with welling tears that my counterpart and I hang our heads and depart.<br/><br/>It’s a story we knew the likely end to, but it doesn’t make it a bit easier.</p><p>--</p><p><strong>3:47 am</strong><br/><br/>Whenever I come back from the floor, I have responsibilities. <br/><br/>First, I change my scrubs. Especially in a situation where each compression is spewing aerosolized COVID into the air, I don’t take any chances. Second, I restock my supplies, both equipment and PPE. Third, I have to chart the procedure I performed. This is where I lose time, because I’m reading notes, interpreting lab values, and trying to understand how this patient possibly progressed to this point. I don’t need to do this, but I find it important to my own closure, and also, it gives me a better clinical picture of how these patients present.<br/><br/>But now, I’m lying in my call bed, and I can’t sleep. It’s the same every night – I go to intubate, come back, and it takes so long to decompress from that situation that by the time I manage to fall asleep, my phone rings and I’m right back at it.</p><p>This time, though, it’s the patient. I can’t wipe his face from my mind. Someone younger than me just died in front of my eyes, and I can’t help but wonder about him. Who he was, who he leaves behind, his hopes and dreams, if he was scared.<br/><br/>With another set of welling tears, I sigh and reach for my phone. I try to focus on healthy behaviors to the best of my ability, but sometimes the distraction of the ridiculous shit I find on the internet is necessary.<br/><br/>Whatever algorithm I’ve amassed knows me well. The first handful of things I see are my internet favorites – dark humor memes, general shitposting, lots of sarcasm. I crack a smile at how people come up with some of this shit, and then my smile fades.<br/><br/>I scroll into posts by the COVID deniers. The photos of people in large groups without masks. Articles shared by those who claim to be my loved ones accusing me of fabricating my daily experience for financial gain. Private messages of friends and family yelling at me to give my patients untested treatments, though I am in charge of no such things. The irony of my friends thanking me for my work and then posting harmful misinformation gives me whiplash. I thought they cared about me and at this point, I don’t know how I’ll be able to look some of them in the eye again.<br/><br/>I let my screen go dark and heave a wobbly sigh.</p><p>My days on the force made me feel tough as nails - I didn’t get the nickname ‘Iron Vixen’ by chance. But this experience has truly broken me in a way that I struggle to find words for.<br/><br/>My phone rings again and my weary body stands to rise, heart beating and tears threatening to fall. And I realize that maybe I’m not so tough, after all.</p>
  </div></div>
</body>
</html>